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Cranial Base Superimposition of Cone-Beam Computed Tomography Images

A Voxel-Based Protocol Validation

Haas Junior, Orion Luiz DDS, MSc, PhD*,†,‡; Guijarro-Martínez, Raquel MD, PhD*,‡; Sousa Gil, Ariane Paredes de DDS*,‡; Méndez-Manjón, Irene DDS, PhD*,‡; Valls-Otañón, Adaia MD, PhD*,‡; de Oliveira, Rogério Belle DDS, PhD; Hernández-Alfaro, Federico MD, PhD*,‡

doi: 10.1097/SCS.0000000000005503
Clinical Study: PDF Only

Objectives: The primary objective of the present study was to find the gold-standard accuracy of voxel-based superimposition of cone-beam computed tomography (CBCT) datasets with a protocol developed for the Dolphin Imaging 3D software. The secondary objectives were to analyze reproducibility and efficiency of this protocol.

Study Design: Twenty-five CBCT datasets of patients with dental implants present were selected. Each Base Volume dataset was duplicated to create a second volume. Subsequently, both volumes were superimposed with a voxel-based protocol consisting of 3 successive steps “Side-by-side Superimposition”; “Overlay Superimposition”; and “Export Orientation to 2nd Volume”. The protocol's accuracy was evaluated by measuring the mean distance between the apex of each dental implant on the Base Volume and second volume datasets. Efficiency was given by the mean time needed to complete all superimposition steps. Reproducibility was analyzed by calculating the intraclass correlation coefficients.

Results: Mean time needed to complete the protocol was 198 seconds. The protocol had a rotational accuracy of 0.10° to 019° and a translational accuracy of 0.20 to 0.24 mm. Intra-observer and inter-observer reproducibility were 1 and 0.921 to 1, respectively.

Conclusions: The protocol is accurate, precise, reproducible, and efficient. The validation of this method enables unbiased analysis of surgical outcomes based on a single, user-friendly software product that is widely available in academic and clinical settings.

*Institute of Maxillofacial Surgery, Teknon Medical Center, Barcelona, Spain

Department of Oral and Maxillofacial Surgery, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil

Department of Oral and Maxillofacial Surgery, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain.

Address correspondence and reprint requests to Orion Luiz Haas Junior, DDS, MSc, PhD, Pontifícia Universidade Católica do Rio Grande do Sul, PUCRS, Av. Ipiranga, n.6681, Building 6, Porto Alegre, RS 91530-001, Brazil; E-mail:

Received 31 July, 2018

Accepted 24 February, 2019

Orion Luiz Haas Junior and Raquel Guijarro-Martínez Both co-authors contributed equally to this work.

All patients provided written informed consent for the use of their CBCT scans and the Teknon Medical Center ethical committee approved the study (CIR-ECL-2012-03).

Brazilian Ministry of Education, Coordination for the Improvement of Higher Education Personnel (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, CAPES), Programa de Doutorado Sanduíche no Exterior (PDSE), grant no. 99999.006660/2015-00 awarded to Orion Luiz Haas Junior.

The authors report no conflicts of interest.

© 2019 by Mutaz B. Habal, MD.